Role Description
This position oversees workflow and productivity for system health record coding, abstracting functions, DRG (Inpatient) and APC (Outpatient) assignment and validation. Provides resources to the hospitals, surgery centers and clinics in order to maintain the DNB (Discharge Not Final Billed) turnaround process, and productivity standards. Provides leadership for assigned section and participates in administrative functions for department, including hiring, evaluating and terminating. Works closely with the Network Coding Manager and the Senior Network HIM Director to ensure timely reimbursement/billing be met consistently based on monitoring the Discharged Not Final Billed (DNFB) report. Designs and develops innovative ways to decrease DNFB.
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Inpatient:
Establishes policies and procedures, and operational benchmarks for system-wide standardization for best practices with ICD-10-CM, ICD-10-PCS Coding.
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Outpatient:
Established policies and procedures and operational benchmarks for system-wide standardization for best practices with ICD-10-CM, CPT, and HCPCs Coding.
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Inpatient/Outpatient:
Serves as a resource for coding staff regarding questions, situations, and/or problem solving.
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Plans and coordinates monthly educational forums for coding staff and ancillary personnel to ensure correct coding and compliance with third party payers regarding billing/reimbursement activities.
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Keeps current with federal legislation, periodicals and publications establishing correct coding/reimbursement compliance.
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Sets priorities and scheduling to ensure that reimbursement and billing suspense days be met consistently, including monitoring the failed bill (incomplete abstract) report.
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Actively and collaboratively participates in special projects, training and/or other duties as assigned by Network Coding Manager.
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Assigns and sequences ICD-10-CM, ICD-10-PCS codes for all inpatient accounts for billing and reimbursement.
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Assigns and sequences ICD-10-CM, CPT, and HCPCs codes for all patient types which may include but not limited to: outpatient, observation, ambulatory records, and emergency room records for billing and reimbursement.
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Maintains and monitors quality of customer service provided to internal and external customers and medical staff to ensure positive outcomes in response to complaints of inadequate service.
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Initiates, prepares and implements process improvements and other projects to maximize system-wide effectiveness regarding HIM.
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Performs other duties as assigned.
Qualifications
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Associates or 2 years' work related experience (Required)
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Bachelors (Preferred)
Requirements
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2 years Inpatient: Hospital inpatient Coding Lead, Auditor, or Trainer experience. Working knowledge of charging and billing process specific to hospital inpatient accounts.
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Outpatient: Outpatient Coding Lead, Auditor, or Trainer experience. Working knowledge of charging and billing process specific to three or more of the following: specialty work types, emergency department trauma, newborn, obstetrics, radiology, infusions, observations, day surgery, laboratory, rehab, interventional radiology, cardiology, or cardiology catheterization laboratory.
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3 years Inpatient/Outpatient: Coding and encoding software experience.
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Other Inpatient: Hospital Coding including complicated accounts, and long length of stay accounts.
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Outpatient: Working knowledge of coding edits: Medicare, NCCI, OCE, LCD, NCD and other claim edit guidelines and protocols.
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5 years Inpatient: Hospital inpatient Coding Lead, Auditor, or Trainer experience. Working knowledge of charging and billing process specific to hospital inpatient accounts.
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Outpatient: Outpatient Coding Lead, Auditor, or Trainer experience. Working knowledge of charging and billing process specific to three or more of the following: specialty work types, emergency department trauma, newborn, obstetrics, radiology, infusions, observations, day surgery, laboratory, rehab, interventional radiology, cardiology, or cardiology catheterization laboratory. (Preferred)
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5 years coding using encoder software and supervisory experience. (Preferred)
License and Certifications
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Inpatient:
CCS (Certified Coding Specialist), or CIC (Certified Inpatient Coder), or RHIT or RHIA (Registered Health Information Administrator) (Required)
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Outpatient:
CPC-H (Certified Professional Coder-Hospital Outpatient), or CPC (Certified Professional Coder), or COC (Certified Outpatient Coder), or CCS (Certified Coding Specialist), or RHIT or RHIA (Registered Health Information Administrator) (Required)
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Inpatient/Outpatient: RHIT or RHIA (Preferred)